Trident sign trumps Aquaporin-4-IgG ELISA in diagnostic value in a case of longitudinally extensive transverse myelitis

Mult Scler Relat Disord. 2018 Jul:23:7-8. doi: 10.1016/j.msard.2018.04.012. Epub 2018 Apr 21.

Abstract

Longitudinally-extensive T2-hyperintense spinal cord lesions (≥3 vertebral segments) are associated with neuromyelitis optical spectrum disorder but occur with other disorders including spinal cord sarcoidosis. When linear dorsal subpial enhancement is accompanied by central cord/canal enhancement the axial post-gadolinium sequences may reveal a "trident" pattern that has previously been shown to be strongly suggestive of spinal cord sarcoidosis. We report a case in which the patient was initially diagnosed with neuromyelitis optical spectrum disorder, but where the "trident" sign ultimately led to the correct diagnosis of spinal cord sarcoidosis.

Keywords: Neuromyelitis optica; Neuromyelitis optica spectrum disorder; Neurosarcoidosis; Sarcoidosis; Transverse myelitis.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aquaporin 4 / analysis*
  • Contrast Media
  • Diagnosis, Differential
  • Enzyme-Linked Immunosorbent Assay*
  • Gadolinium
  • Humans
  • Immunoglobulin G / analysis*
  • Magnetic Resonance Imaging*
  • Male
  • Myelitis, Transverse / diagnosis*
  • Neuromyelitis Optica / diagnosis
  • Spinal Cord / diagnostic imaging*

Substances

  • AQP4 protein, human
  • Aquaporin 4
  • Contrast Media
  • Immunoglobulin G
  • Gadolinium